Expert Review Obstetrics| Volume 2, ISSUE 4, 100185, November 2020

Evidence-based labor management: first stage of labor (part 3)

      There are several interventions during the first stage of labor that have been studied. Vaginal disinfection with chlorhexidine cannot be recommended. Intrapartum antibiotic prophylaxis is recommended for group B streptococcus–positive women. Antibiotic therapy can be considered in women with term prelabor rupture of membranes whose latency is expected to be >12 hours. Aromatherapy with essential oils through inhalation or back massage can be considered. Immersion in water can be considered. Oral restriction of fluid or solid food is not recommended. In the setting of oral restriction, intravenous fluid containing dextrose at a rate of 250 mL/h is recommended. Upright positions and ambulation are recommended in women without regional anesthesia, and women with regional anesthesia can adopt whatever position they find most comfortable and choose to ambulate or not ambulate. Continuous bladder catheterization cannot be recommended. There is no recommended frequency of cervical examinations or sweeping of membranes. The use of a partogram cannot be recommended as a routine intervention. Routine use of the peanut ball cannot be recommended. Antispasmodic agents cannot be recommended. Routine amniotomy alone in normally progressing spontaneous first stage of labor cannot be recommended. Oxytocin augmentation is recommended to shorten the time to delivery for women making slow progress in spontaneous labor, and higher doses of oxytocin can be considered. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended. Routine use of intrauterine pressure catheter and ultrasound cannot be recommended. Cesarean delivery for arrest should not be performed unless labor has arrested for a minimum of 4 hours with adequate uterine activity or 6 hours with inadequate uterine activity in a woman with rupture of membranes, adequate oxytocin, and ≥6 cm cervical dilation.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Berghella V.
        New series of reviews on evidence-based L&D management and cesarean delivery!.
        Am J Obstet Gynecol MFM. 2020; : 2
        • American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics
        ACOG Practice Bulletin number 49, December 2003: dystocia and augmentation of labor.
        Obstet Gynecol. 2003; 102: 1445-1454
        • Hanley G.E.
        • Munro S.
        • Greyson D.
        • et al.
        Diagnosing onset of labor: a systematic review of definitions in the research literature.
        BMC Pregnancy Childbirth. 2016; 16: 71
        • Cunningham F.G.
        • Leveno K.J.
        • Bloom S.L.
        • et al.
        Williams obstetrics.
        24th ed. McGraw-Hill Education, New York2014
        • Zhang J.
        • Landy H.J.
        • Branch D.W.
        • et al.
        Contemporary patterns of spontaneous labor with normal neonatal outcomes.
        Obstet Gynecol. 2010; 116: 1281-1287
        • Berghella V.
        • Di Mascio D.
        Evidence-based labor management: before labor (part 1).
        Am J Obstet Gynecol MFM. 2020; 2
        • Berghella V.
        • Bellussi F.
        • Schoen C.
        Evidence-based labor management: induction of labor (part 2).
        Am J Obstet Gynecol MFM. 2020; : 100136
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Lumbiganon P.
        • Thinkhamrop J.
        • Thinkhamrop B.
        • Tolosa J.E.
        Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding group B streptococcal and HIV).
        Cochrane Database Syst Rev. 2014; : CD004070
        • Ohlsson A.
        • Shah V.S.
        • Stade B.C.
        Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection.
        Cochrane Database Syst Rev. 2014; : CD003520
        • Wiysonge C.S.
        • Shey M.S.
        • Shang J.D.
        • Sterne J.A.
        • Brocklehurst P.
        Vaginal disinfection for preventing mother-to-child transmission of HIV infection.
        Cochrane Database Syst Rev. 2005; : CD003651
        • Verani J.R.
        • McGee L.
        • Schrag S.J.
        Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010.
        MMWR Recomm Rep. 2010; 59: 1-36
        • Ohlsson A.
        • Shah V.S.
        Intrapartum antibiotics for known maternal group B streptococcal colonization.
        Cochrane Database Syst Rev. 2014; : CD007467
        • Verani J.R.
        • Spina N.L.
        • Lynfield R.
        • et al.
        Early-onset group B streptococcal disease in the United States: potential for further reduction.
        Obstet Gynecol. 2014; 123: 828-837
      1. Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion, number 782.
        Obstet Gynecol. 2019; 134: e19-e40
        • Money D.
        • Allen V.M.
        • Infectious Diseases Committee
        The prevention of early-onset neonatal group B streptococcal disease.
        J Obstet Gynaecol Can. 2013; 35: 939-948
        • Lin F.Y.
        • Brenner R.A.
        • Johnson Y.R.
        • et al.
        The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early-onset neonatal group B streptococcal disease.
        Am J Obstet Gynecol. 2001; 184: 1204-1210
        • de Cueto M.
        • Sanchez M.J.
        • Sampedro A.
        • Miranda J.A.
        • Herruzo A.J.
        • Rosa-Fraile M.
        Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus.
        Obstet Gynecol. 1998; 91: 112-114
        • Turrentine M.A.
        • Colicchia L.C.
        • Hirsch E.
        • et al.
        Efficiency of screening for the recurrence of antenatal group B streptococcus colonization in a subsequent pregnancy: a systematic review and meta-analysis with independent patient data.
        Am J Perinatol. 2016; 33: 510-517
        • Saccone G.
        • Berghella V.
        Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials.
        Am J Obstet Gynecol. 2015; 212: 627.e1-627.e9
        • Chen S.F.
        • Wang C.H.
        • Chan P.T.
        • et al.
        Labour pain control by aromatherapy: a meta-analysis of randomised controlled trials.
        Women Birth. 2019; 32: 327-335
        • Cluett E.R.
        • Burns E.
        • Cuthbert A.
        Immersion in water during labour and birth.
        Cochrane Database Syst Rev. 2018; : CD000111
        • Ciardulli A.
        • Saccone G.
        • Anastasio H.
        • Berghella V.
        Less-restrictive food intake during labor in low-risk singleton pregnancies: a systematic review and meta-analysis.
        Obstet Gynecol. 2017; 129: 473-480
        • Ehsanipoor R.M.
        • Saccone G.
        • Seligman N.S.
        • Pierce-Williams R.A.M.
        • Ciardulli A.
        • Berghella V.
        Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis.
        Acta Obstet Gynecol Scand. 2017; 96: 804-811
        • Riegel M.
        • Quist-Nelson J.
        • Saccone G.
        • et al.
        Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor.
        Eur J Obstet Gynecol Reprod Biol. 2018; 228: 284-294
        • Lawrence A.
        • Lewis L.
        • Hofmeyr G.J.
        • Styles C.
        Maternal positions and mobility during first stage labour.
        Cochrane Database Syst Rev. 2013; : CD003934
        • Roberts C.L.
        • Algert C.S.
        • Olive E.
        Impact of first-stage ambulation on mode of delivery among women with epidural analgesia.
        Aust N Z J Obstet Gynaecol. 2004; 44: 489-494
        • Wilson B.L.
        • Passante T.
        • Rauschenbach D.
        • Yang R.
        • Wong B.
        Bladder management with epidural anesthesia during labor: a randomized controlled trial.
        MCN Am J Matern Child Nurs. 2015; 40 (quiz E17–8): 234-242
        • Abukhalil I.H.
        • Kilby M.D.
        • Aiken J.
        • et al.
        Can the frequency of vaginal examinations influence the duration of labour? A prospective randomised study.
        J Obstet Gynaecol. 1996; 16: 22-25
        • Chanrachakul B.
        • Suthutvoravut S.
        • Sangthawan M.
        • Herabutya Y.
        Effect of lower uterine segment sweeping on progress of labor in nullipara.
        J Med Assoc Thai. 2001; 84: 1582-1586
        • Lavender T.
        • Cuthbert A.
        • Smyth R.M.
        Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.
        Cochrane Database Syst Rev. 2018; 8: CD005461
        • Grenvik J.M.
        • Rosenthal E.
        • Saccone G.
        • et al.
        Peanut ball for decreasing length of labor: a systematic review and meta-analysis of randomized controlled trials.
        Eur J Obstet Gynecol Reprod Biol. 2019; 242: 159-165
        • Rohwer A.C.
        • Khondowe O.
        • Young T.
        Antispasmodics for labour.
        Cochrane Database Syst Rev. 2013; 2013: CD009243
        • Smyth R.M.
        • Markham C.
        • Dowswell T.
        Amniotomy for shortening spontaneous labour.
        Cochrane Database Syst Rev. 2013; : CD006167
        • Bugg G.J.
        • Siddiqui F.
        • Thornton J.G.
        Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour.
        Cochrane Database Syst Rev. 2013; : CD007123
        • Kenyon S.
        • Tokumasu H.
        • Dowswell T.
        • Pledge D.
        • Mori R.
        High-dose versus low-dose oxytocin for augmentation of delayed labour.
        Cochrane Database Syst Rev. 2013; : CD007201
        • Wei S.
        • Wo B.L.
        • Qi H.P.
        • et al.
        Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care.
        Cochrane Database Syst Rev. 2013; : CD006794
        • Bakker J.J.H.
        • Janssen P.F.
        • van Halem K.
        • et al.
        Internal versus external tocodynamometry during induced or augmented labor.
        Cochrane Database Syst Rev. 2013; : CD006947
        • Popowski T.
        • Porcher R.
        • Fort J.
        • Javoise S.
        • Rozenberg P.
        Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial.
        Ultrasound Obstet Gynecol. 2015; 46: 520-525
        • Rouse D.J.
        • Owen J.O.
        • Savage K.G.
        • Hauth J.C.
        Active phase labor arrest: revisiting the 2-hour minimum.
        Obstet Gynecol. 2001; 98: 550-554